How quickly do fasciculations spread in ALS?

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Only if your doctor suspected ALS. I suspect they do not think ALS.
 
Really hopeful you are right. EMG is on Tuesday, just praying for it to be normal.
 
I had my first EMG/NCS yesterday. It is not as much fun as a massage, but you can deal with it. I am undergoing the "rule out ALS phase" now. I went to anALS clinic where all docs are board certified Neuros and Phcychiatrists. However, my EMG was inconclusive and I was diagnosed with "EMG Disease" had to google that even after the explanation.
 
Congratulations. Sounds like you have something more rare than ALS. But at least its not ALS!
 
Fasciculations caused by ALS are due to dying muscle tissue (actually necrotic). So, fasciculations due to ALS are always accompanied by muscle weakness and EMG changes.
In ALS they can begin in any muscle but usually it is the leg, but it can be the bulbar muscles, arms, etc. This will vary in a particular patient. In the early part of ALS they tend to be in specific muscles, more distinct, because the muscle is dying.

Fasciculations can be seen in a number of diseases, such as nemaline rod myopathy. So, if there is muscle weakness with EMG changes, then fasciculations are due to a specific disease.

Benign fasciculations are not due to dying muscle tissue, but irritated muscle membranes. They are not accompanied by muscle weakness, nor are there EMG changes.

When they occur in isolation, they are usually of the benign variety. Any and every neurologist will tell you this. Whether they occur in specific areas of the muscle is variable.

Benign fasciculations are usually more spread between muscle groups and can worsen with anxiety and fatigue. They can reoccur in the same muscle groups and also be variable. Since muscle is not dying in benign fasciculations, they tend to be spread out and in a variety of muscle groups.


Hope this helps and clarifies your doubts about the difference between "ALS fasciculations" and the "Benign" ones.
 
Fasciculations caused by ALS are due to dying muscle tissue (actually necrotic). So, fasciculations due to ALS are always accompanied by muscle weakness and EMG changes.
In ALS they can begin in any muscle but usually it is the leg, but it can be the bulbar muscles, arms, etc. This will vary in a particular patient. In the early part of ALS they tend to be in specific muscles, more distinct, because the muscle is dying.

Fasciculations can be seen in a number of diseases, such as nemaline rod myopathy. So, if there is muscle weakness with EMG changes, then fasciculations are due to a specific disease.

Benign fasciculations are not due to dying muscle tissue, but irritated muscle membranes. They are not accompanied by muscle weakness, nor are there EMG changes.

When they occur in isolation, they are usually of the benign variety. Any and every neurologist will tell you this. Whether they occur in specific areas of the muscle is variable.

Benign fasciculations are usually more spread between muscle groups and can worsen with anxiety and fatigue. They can reoccur in the same muscle groups and also be variable. Since muscle is not dying in benign fasciculations, they tend to be spread out and in a variety of muscle groups.


Hope this helps and clarifies your doubts about the difference between "ALS fasciculations" and the "Benign" ones.


Hi Carlos,

In regards to those sentences... I think maybe each clinic has its own way of doing EMGs and making the results.. (maybe)

For instance, I have always had seasons with bodywide twiches... but lately (for last 3months) I started having them localized my right calf, also the leg was feeling week..

EMG results were: cubital/carpal bilateral (both arms) and s1 root irritation bilateral (sciatica perhaps).... The frightening thing is that its says irritated muscle membranes (denervation) bilateral for both external calves.... and polyphasic motor units potentials on peroneus longus....

They didn't diagnosed me with ALS... but for s1 and neuropathy in arms described above, yet my right foot is giving me some problems for walking and recently started twitching... soo i'm just waiting frustrated, of course....

I think ALS is so different sometimes, you just don't know what to expect.. Yesterday I was reading about Pete Frates, baseball player, young guy, my age, that got diagnosed after getting a damaged nerve in a wrist and it never healed..


anyway, bless you all

Jon
 
So I had my EMG on Tuesday and the results were normal.

The EMG itself took just five minutes. Is this normal? I was expecting it to be 15 minutes or longer. My fasciculations were quite weak at the time (they seem to vary in strength and speed a lot), but even so, if there was anything there, it would've been detected even if the fasciculations weren't visible, right? The needles were put in my right upper arm and in two places in my right leg. I've read about people on this forum having an EMG "too early," but since my muscles are twitching, it's safe to assume it's not too early in my case? Or should I get a follow-up EMG done six months from now?

On the one hand, this is a huge relief. If the results were normal, ALS can be completely ruled out, right? I've read some posts from people here about having an EMG too early, but considering that I am experiencing fasciculations, that can't be the case for me, can it? Should I request a follow-up in six months?

On the other hand, the weakness and clumsiness in my right arm is definitely still there. I've been typing this response for less than a minute and my right hand is already aching, and the muscles in my right arm hurt when I move it. There's also less muscle tone in my upper right arm than there is on my left.

My question is, can I safely discard ALS now? And does anyone have any clue what could be affecting my arm? The neuro simply dismissed me by telling me he didn't know what I had, and forwarding all my files and tests to my original neurologist, who I'm going to meet next week.
 
I would save all those questions for the dr next week. You need to relax in the mean time. This process could take months even years to figure out. I know how hard that is but bouncing from dr to dr is not going to make things better. It will only make you appear neurotic to the drs. Sometimes it takes progression to narrow down the possibilities of illness. Don't narrow your focus on als, many of these diseases mimic each other. Let the dr do their job, you are the patient, they went to school for a long time and know more than you do. You have researched online and are second guessing everything.

You need to stop, relax, no self testing and find something you enjoy doing and go do it. No matter how bad you want answers now you can't rush the answers. I am not saying give up but to just be patient. I hope you find peace.
 
The reason I thought it might be ALS is because of the physical symptoms plus the family history, but I was hoping the clean EMG would mean I could relax a little. I just don't know at this point. Like you said, this process could take months or years. Maybe the MRIs will reveal something. I was just hoping that I could at least discard ALS at this point, and that some of the folks here could tell me if I could do that, but I understand that it's just too soon to think about anything.
 
I am speaking from experience. It took 5 years to find my answers. I was afraid and wanted answers just like you but the longer into my journey the more I realized that in the scope of things I wasn't going to let it change my life. I was wasting time waiting around worrying and over thinking everything.

I got to a point where I decided it is what it is and that I may never find answers. I unlike some here I don't know all the numbers of my emgs, + or -, brisk or whatever. It wouldn't mean anything to me, that is not what defines me. I let my dr worry about that, its not like I can change it. I have too many other things to think about. I have a life to live and people to love.

All that early worrying didn't change anything, it didn't prepare me for anything, all it did was cause wasted time lost I will never get back.
 
Take ALS out of the equation will ya? Stop second guessing the neuro. . If he/she thought you needed to be seen in six months for another EMG, you would surely have been told. If the muscle tone difference you describe is significant, it would have been noted. ( no one body is perfectly symmetrical). These nerdy ( in a good way) neuros. study for what 8 - 12 years?

OK - so you have perceived weakness - it's not fatal. It's likely more annoying than anything else. Eventually you'll get answers. Or not.

I feel that I'm happier for you, than you are for yourself, or so it seems.
 
Take ALS out of the equation will ya? Stop second guessing the neuro. . If he/she thought you needed to be seen in six months for another EMG, you would surely have been told. If the muscle tone difference you describe is significant, it would have been noted. ( no one body is perfectly symmetrical). These nerdy ( in a good way) neuros. study for what 8 - 12 years?

OK - so you have perceived weakness - it's not fatal. It's likely more annoying than anything else. Eventually you'll get answers. Or not.

I feel that I'm happier for you, than you are for yourself, or so it seems.


Well, I was told via message here that a normal EMG doesn't necessarily mean anything. I want to feel relieved but after what I've heard, I'm not sure if I should? I still don't know what perceived weakness is. Is it weakness you think you have but which can't be measured?
 
Clinical weakness is exactly that. Your physician will conduct strength tests in his/her office to determine actual clinical weakness. My neuro tested every muscle I think I have. He started at my brow moving to eyes mouth cheeks tongue neck all the way down arms to fingers then down legs to toes. When I could not provide resistance against his push or pull of my right foot, he noted that as clinical weakness. He then noted significant atrophy in muscles. After all that I had the EMG/NCS. My EMG showed "EMG Disease". He now believes I have Myotonia ( not sure which one yet). I go back in 3 months to do it all again.
 
Sounds like great news JEB. Congrats!
Clean EMG just makes the odds of having a NMD even that much more remote.
 
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